This invention relates to image shifting in a telerobotic system, and more particularly, to robotically assisted methods and apparatus which are beneficial for use in surgery.
Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue which may be damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. Many surgeries are performed each year in the United States. A significant amount of these surgeries can potentially be performed in a minimally invasive manner. However, only a relatively small percentage of surgeries currently use minimally invasive techniques due to limitations of minimally invasive surgical instruments and techniques currently used and the difficulty experienced in performing surgeries using such traditional instruments and techniques.
Advances in minimally invasive surgical technology could dramatically increase the number of surgeries performed in a minimally invasive manner. The average length of a hospital stay for a standard surgery is significantly longer than the average length for the equivalent surgery performed in a minimally invasive surgical manner. Thus, expansion in the use of minimally invasive techniques could save millions of hospital days, and consequently millions of dollars annually, in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work can also be reduced by expanding the use of minimally invasive surgery.
Traditional forms of minimally invasive surgery include endoscopy. One of the more common forms of endoscopy is laparoscopy, which is minimally invasive inspection or surgery within the abdominal cavity. In traditional laparoscopic surgery a patient""s abdominal cavity is insufflated with gas and cannula sleeves are passed through small (approximately xc2xd inch) incisions in the musculature of the patient""s abdomen to provide entry ports through which laparoscopic surgical instruments can be passed in a sealed fashion.
The laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field and working tools defining end effectors. Typical surgical end effectors include clamps, graspers, scissors, staplers, and needle holders, for example. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an approximately 12-inch long extension tube, for example, so as to permit the surgeon to introduce the end effector to the surgical site and to control movement of the end effector relative to the surgical site from outside a patient""s body.
To perform surgical procedures, the surgeon typically passes these working tools or instruments through the cannula sleeves to the internal surgical site and manipulates the instruments or tools from outside the abdomen by sliding them in and out through the cannula sleeves, rotating them in the cannula sleeves, levering (i.e., pivoting) the instruments against the abdominal wall and actuating the end effectors on the distal ends of the instruments from outside the abdominal cavity. The instruments normally pivot around centers defined by the incisions which extend through the muscles of the abdominal wall. The surgeon typically monitors the procedure by means of a television monitor which displays an image of the surgical site via the laparoscopic camera. Typically, the laparoscopic camera is also introduced through the abdominal wall so as to capture an image of the surgical site. Similar endoscopic techniques are employed in, e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy, and the like.
There are many disadvantages relating to such traditional minimally invasive surgical (MIS) techniques. For example, existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Difficulty is experienced in approaching the surgical site with the instruments through the small incisions. The length and construction of many endoscopic instruments reduces the surgeon""s ability to feel forces exerted by tissues and organs on the end effector of the associated instrument. Furthermore, coordination of the movement of the end effector of the instrument as viewed in the image on the television monitor with actual end effector movement is particularly difficult, since the movement as perceived in the image normally does not correspond intuitively with the actual end effector movement. Accordingly, dexterity and sensitivity of endoscopic tools has been found to be an impediment to the expansion of the use of minimally invasive surgery.
Minimally invasive telesurgical systems for use in surgery have been and are still being developed to increase a surgeon""s dexterity as well as to permit a surgeon to operate on a patient in an intuitive manner. Telesurgery is a general term for surgical systems where the surgeon uses some form of remote control, e.g., a servomechanism, or the like, to manipulate surgical instrument movements, rather than directly holding and moving the tools by hand. In such a telesurgery system, the surgeon is typically provided with an image of the surgical site on a visual display at a location remote from the patient. The surgeon can typically perform the surgical procedure at the location remote from the patient whilst viewing the end effector movement during the surgical procedure on the visual display. While viewing typically a three-dimensional image of the surgical site on the visual display, the surgeon performs the surgical procedures on the patient by manipulating master control devices at the remote location, which master control devices control motion of the remotely controlled instruments.
Typically, such a telesurgery system can be provided with at least two master control devices (one for each of the surgeon""s hands), which are normally operatively associated with two robotic arms on each of which a surgical instrument is mounted. Operative communication between master control devices and associated robotic arm and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor which relays input commands from the master control devices to the associated robotic arm and instrument assemblies and from the arm and instrument assemblies to the associated master control devices in the case of, e.g., force feedback, or the like.
To enhance the capabilities and acceptance of teleoperation systems, it is an object of the present invention to provide improved teleoperation methods, systems, and devices. It would be particularly beneficial to provide improved techniques for shifting an image shown to a system operator using a teleoperator system, especially for telesurgical applications. It would further be beneficial if these improved techniques enhanced an operator""s control over the system while modifying an image. It is an object of this invention to provide a method of performing an image shift while inhibiting the loss of the surgical instruments from the field of view of the endoscope.
In a first aspect, the invention provides a method of preparing to perform or performing a procedure at a worksite with a robotic system. The method comprises capturing an image of the site with an image capture device. The captured image is displayed on an image display to be viewed by an operator of the robotic system. The operator is permitted to manipulate a master control, causing an end effector to perform at least a part of the procedure at the site. The master control is selectively caused to be operatively associated with the displayed image, and the displayed image is changed in response to manipulation of the master control.
In another aspect, the invention provides a surgical system for performing a surgical procedure at a surgical site on a patient body. The surgical system comprises an image capture device for capturing an image of the surgical site. An image display is coupled to the image capture device for displaying the captured image to an operator of the surgical system. An instrument arm has a mounting formation defined at one end, with a surgical end effector operatively mountable on the mounting formation. A master control is often coupled to a control system, with the control system arranged to permit the master control to be operatively associated with the surgical end effector so as to cause the surgical end effector to move and perform at least a part of the surgical procedure in response to manipulation of the master control, and also to permit the master control to be selectively operatively associated with the displayed image to enable the displayed image to be changed in response to manipulation of the master control.
In another aspect, the invention provides a method for preparing for or performing a procedure. The procedure comprises manipulating an object at a worksite per instructions of an operator. The method comprises showing an image of the object to the operator using a display. An input device is manipulated with a hand of the operator and the image shown on the display is moved in response to the manipulation of the input device so that the image of the object shown to the operator appears substantially connected to the input device.
In yet another aspect, the invention provides a robotically assisted surgical system. The surgical system comprises a display and an image of a tissue shown on the display. An input device is movable relative to the display. A processor couples the input device to the display. The processor effects movement of the image on the display in response to movement of the input device so that the tissue appears substantially connected to the input device.
In yet another aspect, the invention provides a telerobotic system comprising a viewer and a camera positionable at a remote site. The camera is mounted on a robotic arm to enable it to be positionally adjusted at the remote site. The camera is operatively associated with the viewer to enable an image of the remote site to be displayed on the viewer. A slave instrument or tool is positionable at the remote site. The tool is mounted on a robotic arm to enable it to be worked at the remote site. A master control device is in close proximity to the viewer to enable it to be manipulated by a user of the system while the user is viewing the remote site through the viewer. The master control device can selectively establish control over the robotic arm of the camera and to the robotic arm of the slave instrument so that positional adjustment of the camera and working of the tool can be effected by the master control.
In a still further aspect, the invention provides, for use with a robotic system (including a viewer operatively associated with a remote camera arrangement so as to display an image viewed by the camera on the viewer, and at least two master control devices each of which is operatively connected to a remote instrument or tool so as to cause displacement of the instrument or tool in response to displacement of its associated master control device) a method of shifting the image relative to the instrument or tool. The method comprises locking the instruments at stationary positions and moving the master control devices relative to the viewer while movement of the master control devices relative to each other is restrained. The camera is caused to displace relative to the instruments while the instruments are held at their stationary positions in response to the master control devices being displaced relative to the viewer.
A still further aspect provides a robotic surgical system comprising an image capture device for viewing a surgical workspace. A display is operatively coupled to the image capture device to show an image of the surgical workspace adjacent a controller workspace. The master controller is movable in the controller workspace. A surgical end effector is disposed in the surgical workspace. A processor couples the master controller to the image capture device and to the end effector. The processor has a first operating mode effecting movement to the surgical end effector such that the end effector in the image follows movement of the master controller in the controller workspace. The processor also has a second operating mode effecting movement to the image capture device so that the surgical workspace in the image follows movement of the master controller in the controller workspace.
In yet another aspect, the invention provides a telerobotic system comprising a viewer, an image capture device coupled to the viewer to produce an image of a workspace, and a robotic arm having an end effector disposed in the workspace. A processor couples the image capture device to the robotic arm so as to maintain an image of the end effector within the image of the workspace.
Other features and advantages of the invention will appear from the following description in which the preferred embodiment has been set forth in detail in conjunction with the accompanying drawings.